Managing Properly Worker Compensation Dental Claims

If you are a claims adjuster or a nurse case manager, you know that managing WC claims can sometimes be difficult. These claims occur quite frequently, and you need to pay special attention to some important factors when resolving the case.

A worker can get an injury to the mouth, jaw or teeth very easily through a car accident, a slip & fall or in a construction and manufacturing accident, and then he/she would need proper dental care.

Here are a few important steps that should be taken into consideration by adjusters when they manage dental claims:

Finding the proper dental professional who will offer proper dental care for the injured, so that he/she can return safely and quickly to work. The best thing you can do is to search for a reliable dentist through a specialized network, since workers compensation providers’ main focus is not to recruit dentists.

Choosing the right dental plan – many times, dentists might provide too much treatment, which automatically results in higher costs for the workers’ compensation.

For instance, if a worker simply chips his teeth in a minor accident, the dentist might find other damages unrelated to this accident such as cavities, or gum disease and start treating them.

This might result in a bill of $2,000+ for the payer, when all that needed to be treated was a simple chipped tooth. Therefore make sure, that a proper dental plan will be chosen that includes treatment for the work related injury and will not take into consideration the entire dental history of the patient.

Let specialty networks make the referrals and recommendations – a jaw, mouth or tooth injury does not necessarily mean that the patient needs only a dentist. It may be the case that a dental specialist such as a periodontist, an endodontist or a maxillofacial surgeon is needed to treat the problem effectively.

After treatment support & advice – dental claims vary from the simple and up to the most complex ones. It is very important to make sure that the patient gets all the care that he needs after the treatment. For example, a dental filling is a procedure that will be generally solved with one or maximum two visits to the dentist.

On the other hand, if the worker needs a dental implant due to the fact that his lost tooth cannot be repaired, this is a procedure that needs much more treatment time, but also multi specialty provider coordination.

Thus treatment time will be effectively organized, and the patient will get all the care that he needs, so that he can return to work as soon as possible. A specialized dental network can help you with all these, and offer proper after treatment advice and support.

Assuring dental reserves – again, a specialized dental network can help organizing the financial resources needed for the treatment. It also works closely with adjusters in order to set up the right dental plan with cost estimates included.

Managing the most costly dental related injury – the TMJ disorder- temporomandibular joint disorders require treatments that are very expensive, and they definitely require the best experts in the field to treat them. The costs of a joint replacement with injections and fat grafting can easily exceed $100,000.

Therefore, make sure to work closely with a specialized dental network that can help finding the best treatment solutions, and the most advantageous health plans out there.